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Should hospitals specialize?
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Results so far:
| Yes | 57% | 21 votes | Total: 37 votes | |
| No | 43% | 16 votes |
Yes
by Sita
Created on: May 20, 2008
I live in an area where we are lucky to have a great many specialized hospitals. There is a stroke center, a heart center, a children's hospital, and one of the leading cancer institutes in the country. It's good to know that all of these are right in my own backyard.
As a soon-to-be nurse, I know firsthand of some of the benefits of having specialized hospitals. There is expensive equipment that smaller hospitals cannot afford, but a larger or specialized institution may have budget or funding for. Expert doctors and surgeons are attracted to the hospitals as specialists, and you have a higher level of skill on hand. Nurses in specialty areas often receive extra training, and there is greater job satisfaction on part of all employees knowing that their place of employment has received recognition as someplace special. This pride and sense of satisfaction translates directly into the quality of patient care.
While local and general hospitals are still needed- in fact, I plan to work at one in just a few months- it's good to know that if a special situation does arise, a patient can be transported somewhere where they will receive specialized care. Specialized institutions usually have a greater capacity for research, also- and this eventually leads to a higher standard and better knowledge base for all practitioners to work with. There's no question that, while a general hospital provides a great resource for healthcare, trauma or specialty centers have that extra ability that may make the difference in a lot of cases.
The argument against specialty hospitals that comes up often is that of cost. For the most part, it is HMOs and insurance companies that decide reimbursement and in essence, set costs. Specialty hospitals are, in many instances, more likely to be granted funding, and also more able to raise their own funds via the public. Ask a family member of a patient with a rare condition or who has sought out a specialty hospital whether or not they are worth having, or whether or not they feel the cause is worth supporting. Chances are they will stand up for the hospital and may even donate to them on their own.
In my area, it is Roswell Park Cancer Institute. In Ohio, and even in this area as well, the Cleveland Clinic comes up any time any complex condition is diagnosed. It takes a lot of work, upkeep, education, and resources to become a specialized institution, and it takes the dedication and belief of a lot of staff to keep up with the training and requirements.
All hospitals provide a wonderful service, and every one of them is worth having. In this day and age where healthcare costs are rising and hospitals are closing their doors, it seems easy to say "get rid of the specialists and go back to how things used to be." But if it were my family member, my parent or child- or me myself, I'd take the specializing hospital any day. No offense to any other hospital, and yes, part of it is just the attitude of the times where we want the best there is, but there is something wonderful to be said for just having available to us a specialized hospital if we did need it. Just in case, it brings peace of mind knowing they're there, and it would be a great shame if they were phased out of existence.
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No
by Hannah Russell
Created on: May 19, 2010
Whenever a doctor is figuring out what is wrong with you, he or she is hardly ever just looking at the symptoms and the correct diagnosis pops into their head. This would be one step short of voodoo. Doctors go through a long line of differential diagnoses that are each confirmed or refuted by different factors, lab results, test results, histories and situations. Sometimes, doctors are operating under the assumption that one diagnosis is correct. Then, a new symptom presents, new information is brought to the table and doctors are back to, maybe not square one, but perhaps square three.
Imagine you are in a hospital, being treated for hypertension. At first, they think that your hypertension is related to an underlying vascular cause. Some more information is brought in, and all the sudden, they decide that your hypertension is actually based in your kidneys. It is not a case for the vascular doctor, it is for the nephrologist. Well, my friend, you are not lucky today. You are in a vascular specialty hospital, the nearest nephrology hospital is across town, and consequently the nearest nephrologist is also across town. The doctors cannot just run down to the next floor to talk to the nephrologist about it, they have to call them up and possibly bring the nephrologist across town to see you. Sure, they can send them the results, talk to them on the phone, but something in physical features or some such subtle thing that is important to the nephrologist seemed completely and entirely irrelevant to the vascular specialist. When the nephrologist gets there three hours later—there was traffic—the nephrologist informs your attending vascular doctors that this is not a nephrology problem at all. Oh no, your hypertension is based in your endocrine system. Not one of those hospitals until the next town over. Fourteen hours later, you are released from the vascular hospital; the majority of your time was spent while your doctors conferred with other hospitals, and are ready to ride to the next town over for the endocrine hospital. Come now, you cannot tell me that this was not fun! All the same, you cannot help but wonder if what would happen if they just kept all these doctors inside the same hospital.
Medicine is not an issue of one specialty. Medicine is, and will always be, a multi-disciplinary science. Even when doctors know what the situation is, most care teams have at least six or seven different professionals on them. It is silly to think that you can separate by disease, disorder or body system.
Further, doctors can be wrong. It happens all the time. However, it is harder for a doctor to see what is wrong about their diagnosis and where you should really be if they have never worked in any other area. Of course someone who works with strokes all day will be able to diagnose a stroke. That does not mean that they will be able to see comorbid condition, an underlying condition, or that the diagnosis is just plain wrong. Hospitals need to have doctors and professionals of all specialties involved, bringing their experience and input to the table so that patients can have optimal care planning.
It is also not cost-effective to have a hospital that works with one disease, disorder or system. A hospital administrator is a hospital administrator. One hospital administrator runs the Zollinger-Ellison Hospital, which gets hardly any patients, and another the Myocardial Infarction Hospital, which is always a hopping place. This does not mean that the first makes significantly less or gets significantly less benefits than the second gets. The first administrator is bored all day, and the second completely over-worked. It seems a good idea to equalize the work evenly across all the hospital administrators.
Sure, it is reassuring for a family to know that their loved one is under the care of people who have done this before—many times before. However, you had better hope they are right about what your loved one has, or they will be missing the entire picture.
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